Clinical impact of clonal hematopoiesis on patients with solid tumors: a systematic review and meta-analysis

Clonal hematopoiesis (CH) is a common age-related phenomenon associated with an increased risk of hematologic malignancies and cardiovascular disease. Its prognostic significance in patients with solid tumors remains unclear. The aim of this meta-analysis was to evaluate the association between CH and clinical outcomes, including overall survival (OS), progression-free survival (PFS), cardiovascular events, and all-cause mortality in patients with solid tumors.

We conducted a meta-analysis according to PRISMA guidelines, including 21 studies comprising 4845 patients with CH and 63557 patients without CH. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals were pooled using random-effects or fixed-effects models as appropriate, based on assessments of between-study heterogeneity.

CH was not significantly associated with OS in patients with solid tumors (HR: 1.10, 95% CI: 0.92-1.32, p = 0.30). The pooled analysis using a random-effects model suggested a trend toward improved PFS in patients with CH compared with those without CH, although statistical significance was not reached (HR: 0.83, 95% CI: 0.67-1.02, p = 0.08). However, CH was associated with an increased mortality in patients with solid tumors, with nearly a twofold higher risk compared to those without CH (OR = 1.70, 95% CI: 1.34-2.16, p < 0.00001). Furthermore, CH was significantly associated with an increased risk of cardiovascular events (OR = 2.75, 95% CI: 1.38 to 5.47, p = 0.004).

Our meta-analysis indicated that CH mutations have a prognostic value and are associated with a clinically meaningful increased risk of overall mortality and cardiovascular events in patients with solid tumors.